Programs & Services

GOAL 4

Create pathways for access to a full range of IECBH programs and services providing promotion, prevention, and treatment

Strategy 4.1 Ensure equitable access to all IECBH services including prevention and treatment Services

Rationale: Every child in Hawaiʻi, birth to age 5, should be screened at regular intervals to determine whether that child should receive interventions within family and community settings or move to a higher level for assessment or treatment. Families and providers should experience seamless transitions between levels of services and across program/agency settings. Ensuring reliable access to prevention and treatment services for children, ages birth to 5, and their families will reduce future spending on special education, medical treatment and juvenile justice. The Federal Mental Health Parity Law7 requires publicly- and privatelyinsured children to have access to mental health services equal in scope, duration, and accessibility to those with physical health conditions. Models must exist for both publicly- and privately-insured children and families.

IECBH Plan cross-sector leadership team (the Team) adapts and ratifies the SMART framework8 for expansion of IECBH prevention and treatment services

Recruit/secure a primary care provider/pediatrician as a member of the Team

Determine and strengthen entry points for IECBH services and treatment through primary care, pediatricians, and other clinical settings by considering procedures such as shared enrollment forms and “no wrong door” for service access

Create integrated intake, screening, and assessment strategies to support connections between services and improve collaboration across systems Build a common infrastructure connecting health, human services and social services organizations

Evaluate Hawaiʻi’s current prevention and treatment services and assess the tiers of the intervention pyramid and national best practices for service density and capacity

Identify points of entry for prevention and treatment services and determine if families access services successfully through those points of entry

Encourage pregnant women and new parents to enroll in text programs to access free information, sent by text, designed to fit due date and child’s first few years of life Provide training and technical assistance to treatment providers on the use of the SMART framework to strengthen an integrated and seamless IECBH system

Strengthen and connect existing alliances focused on prevention and treatment activities for collaborative actions on program and practice changes

Advocate for inclusion of “whole family” government/non-government approaches to IECBH services, including attention to maternal mental health, intergenerational and historical trauma, postpartum depression, and multi-generational approaches to treatment options through managed care organizations

Develop and sustain “system navigators” to support referral sources and families in accessing and enrolling into services Pilot placement of navigators into at least three community primary care clinics, with training and ongoing support for the clinics, clinicians and navigators

Evaluate and test models of easily accessible, non-stigmatizing community supports for IECBH interventions in at least three communities on different islands9

Develop a cross-sector plan to improve transitions for families between service sectors, including referrals, coordination of eligibility determination for services, and provision of services across key systems serving infants, toddlers, and preschoolers

Expand and connect families through peer-topeer networks and family support programs to strengthen family capacity, support prevention activities, and improve family engagement and education Expand the use of the SMART framework to strengthen an integrated and seamless IECBH system across most service providers

Expand integrated models of care, relying on preliminary outcomes from pilot sites

Implement or strengthen the availability of least one organization on every island in Hawaiʻi, with a focus on behavioral health needs of the child and family, that utilizes the multigenerational approach to service delivery adopted in Hawaiʻi). The organization will serve as an anchor in the community and share promising practices with others. Evaluate cost savings of this approach over individual therapeutic services delivered to each family member

Evaluate family responses to community support models, cultural fit, and ease of access of the models adopted

Evaluate changes in transitions across systems, including early intervention services, IDEA 619 services, and treatment services

If warranted, expand the use of system navigators based on an examination of cost savings in primary care by shifting responsibilities for screening, referral, and accessing services from physicians to navigators

Strengthen parent advocacy to promote young children’s behavioral health and share awareness of programs with other parents and caregivers

GOAL 4

Create pathways for access to a full range of IECBH programs and services providing promotion, prevention, and treatment

Strategy 4.1 Continued

Expand comprehensive primary prevention to include IECBH through the expansion of twoway texting programs Identify funding sources to begin the development of the IECBH core story that integrates with existing family support texting platforms Strengthen entry points for IECBH services through a comprehensive texting referral management system

Encourage and support engagement of family members to assess IECBH programs and services

Increase use of IECBH consultants across early childhood settings

Develop and deliver curriculum/training modules on an IECBH approach in pediatrics and primary care in Hawaiʻi through a series of sessions Encourage family evaluation of IECBH services to assess goodness of fit within communities and to seek expansion if needed so there are no geographic disparities and continuity across communities

Complete and vet IECBH texting platform with IECBH professionals Develop marketing, outreach and registration process for enrolling in texting platform Ensure there are standard practices and programs of IECBH services across all geographic communities

A comprehensive early childhood two-way texting platform is in place through State agency contracts that gives IECBH support and guidance to families, prenatally through their child’s first three years

Create opportunities for in-person and tele-consultation between early childhood providers and IECBH consultants

Implement additional IECBH-related curriculum/training modules to pediatricians/primary care doctors and allied health professionals and provide tele-health consultation for doctors to implement IECBH practices Identify early adopters committed to integration of IECBH into pediatric and family medicine practices Identify sustainable funding for tele-consultation between pediatricians/primary care clinics and IECBH consultants

GOAL 4

Create pathways for access to a full range of IECBH programs and services providing promotion, prevention, and treatment

Strategy 4.2 Develop and maintain a coordinated and cohesive system for screening, referral, and utilization of services for young children and their families.

Rationale: National guidelines and federal requirements for Medicaid-eligible health care exist for providing developmental screenings at wellchild check-ups. Requirements also exist for screening within certain federally-funded programs (e.g., MIECHV, Early Head Start/ Head Start). Across systems, there is often duplication of efforts in screening young children, with little information shared with families about the rationale for screening and next steps, and no linkage between systems to share data and referral information. Hawaiʻi would do well to develop a cohesive and coordinated system for screening, referral, and utilization, including information on follow-up and access to services.

Support the list of recommended screening tools and establish standards for their use, including frequency of administration based on AAP Bright Futures

Promote use of the DOH Developmental Screening and Referral Guidelines by early childhood providers, including how to share information with families, refer for services, and track access to services following referral

Explore options with Med-QUEST leadership to address quality and consistency of screening in primary care

With cross-sector leaders, set a percentage goal for the rate of birth to five children screened and assessed statewide (e.g., 50% screened by 2022)

Analyze models used in other states and regions to track screening and analyze data that can be utilized by a variety of providers for service improvement and communication with families

Examine the potential implementation of a common infrastructure or national model of screening and referral in one underserved community on Oʻahu

Collaborate with Med-QUEST to develop a plan to certify community-based organizations so they can be reimbursed for screenings and IECBH services Secure sustainable funding for recommended screenings tools for maternal postpartum depression, trauma in both children and parents, and behavioral health screens for all family members

Develop online training modules for screening, referral, and utilization of services to ensure accessibility, availability and greater capability in discussing discuss assessment results and referrals with families

Create quality oversight for HMOs with financial penalties when standards are not met and maintained

Identify and/or develop continuous quality improvement practices around screening, referral and access to services

Select a model for a comprehensive screening database, and secure funding to establish and maintain it

Develop a funding mechanism for the implementation of a selected screening and referral system in at least one underserved community on O‘ahu

Work with Med-QUEST to certify several community-based organizations and support initial billing to Med-QUEST of allowable screening and IECBH services

Establish linkages across systems for collection and access to data on screening, utilizing a unique child identifier to track children through the screening and referral system (universal consent form, data sharing agreements) Promote use of recommended screening tools and make them available to all providers, with technical assistance provided as needed

Evaluate changes in rates of screening and referral based on provider education efforts

Unbundle CPT codes for developmental and behavioral/trauma screening from capitated rates to improve financial reimbursements to primary care and to increase rate of screenings

Evaluate changes related to duplication of screenings, monitoring when screenings indicate potential concern but do not require immediate referral, and improvements in screening rates, referrals and access to services

Provide training and implementation support on the selected comprehensive screening database

Secure funding and expand successes of the selected screening and referral system pilot to other islands in Hawaiʻi

Grow the number of community-based organizations, with attention to equity in geographic spread, that are certified to bill and be reimbursed by Med-QUEST for IECBH screening and services

Evaluate the increase in referrals and enrollment in needed services based on screening results